Our current R01 funded program of research investigates multilevel disparities in access, adherence, and outcomes related to the use of oral anticancer agents (OAAs) in patients with advanced renal cell carcinoma (RCC). However, disparities in cancer care can additionally be driven by issues of cognitive impairment such as dementia, including Alzheimer?s and related dementias (AD/ARD). AD/ARDs exhibit known racial and socioeconomic disparities in incidence, severity, and care, and is known to be increased in patients with renal dysfunction but has not been examined with respect to RCC. AD/ARD therefore may play a substantial role in influencing disparities in kidney cancer patient both respect to treatment and outcomes. This perspective has been largely ignored in health services cancer disparities research. The impact of dementia on cancer patients is likely to grow substantially over the next few decades as 1) the U.S. population ages and 2) cancer care becomes increasingly outpatient-based. We propose to investigate the following in patients with advanced renal cell carcinoma within the SEER- Medicare patient population: Aim 1: To examine risk factors for development of AD/ARD in the RCC patient population. In Aim 1A we will investigate whether RCC patients are at increased risk of AD/ARD. In Aim 1B we will then investigate whether specific RCC-directed therapies, such as partial/radical nephrectomy or chronic use of OAAs, are associated with an increased risk of AD/ARD. Aim 2: To determine the initiation and adherence of OAAs in Medicare patients with dementia and investigate the interaction between socioeconomic status (SES), dementia, and management of patients with advanced renal cell carcinoma. In Aim 2A we will investigate the impact of AD/ARDs on access and adherence to OAAs using benchmarks of access and adherence of other chronic medications in RCC patients with dementia. In Aim 2B we will investigate whether any observed impact of AD/ARDs are exacerbated in at-risk or disadvantaged socioeconomic status populations. Successful completion of this proposal will characterize the bi-directional relationship between RCC and AD/ARDs, including the potential of RCC or related treatment to increase AD/ARD risk, and conversely of an AD/ARD diagnosis to subsequently impact the treatment and outcomes of RCC patients. A deeper understanding of these interactions could help identify when and where in the diagnosis to treatment continuum that interventions may be warranted and/or optimized to improve access, outcomes, and mitigate disparities for the management of both RCC and AD/ARDs.